Introduction

Pelvis is a region where trunk and lower limbs meet Pelvic

cavity: basin-shaped inferior part of abdominopelvic cavity
inferior to the plane of pelvic brim Pelvic brim: extends
from superior border of pubic symphysis to promontory of
sacrum pelvic cavity enclosed by the true pelvis consists of
the pelvic inlet, walls, and floor This cavity is continuous
superiorly with the abdominal cavity and contains elements
of the urinary, gastrointestinal, and reproductive
systems.

Bony pelvis
Formed by 4 bones united by 4 joints
Bones: 2 hip bones, sacrum and coccyx

Joints: 2 sacroiliac joints, pubic symphysis and sacrococcygeal joint

Pelvis is divided by plane of pelvic inlet (pelvic brim) into 2 parts: pelvis major (false
pelvis) and pelvis minor (true pelvis)

Pelvis major: lies between iliac fossa; part of abdominal wall

Pelvis minor: actual pelvis; contains pelvic viscera

Hip bones
The two hip bones are joined at the pubic symphysis anteriorly and the sacrum
posteriorly
Each hip bone is formed by 3 bones fusing at the acetabulum (a cup-like articular
depression on lateral aspect for the head of the femur) by a y-shaped cartilage
Begin to fuse at 15-17 years and complete at 20-25 years of age
–The 3 bones are:
Ilium
Ischium
Pubis

Pubic arch (sub pubic angle)

formed by the ischiopubic rami (conjoined inferior rami of the pubis and ischium) of the
two sides

these rami meet at the pubic symphysis

their inferior borders define the subpubic angle

•the distance between right and left ischial tuberosities

•measured with the fingers in the vagina during a pelvic examination.

It is important for identification of the pelvis (male/female)

Pelvic inlet and pelvic outlet

Pelvic inlet
superior boundary of the pelvic cavity
superior pelvic aperture
It is bounded by pelvic brim

Pelvic outlet
The pelvis is limited inferiorly by the pelvic outlet, the inferior pelvic aperture
bounded by:
•Anteriorly:- Inferior margin of the pubic symphysis
•Anterolaterally:- Inferior rami of the pubis and ischial tuberosities
•posterolaterally :- Sacrotuberous ligaments
•Posteriorly:- Tip of the coccyx
Comparison of male and female bony pelvis

Types Of Pelvis
There are four types of pelvis
Gynecoid type
•normal female type
•its pelvic inlet has a rounded or oval shape and a wide transverse diameter
Android type-
•Masculine, funnel-shaped
•in a woman may present hazards to successful vaginal delivery of a fetus
Anthropoid type,
•is long, narrow, and oval shaped
platypelloid type is a wide pelvis flattened at the brim, with the promontory of the
sacrum pushed forward.
Walls of pelvis
Formed by framework of bones, joints, ligaments & muscles lined by membrane

Anterior wall: pubic bones, obturator internus muscle and pubic symphysis

Lateral wall: obturator internus with obturator membrane

Posterior wall: sacrum, ilium, piriformis muscle

Muscles of the pelvis

1.Lateral pevic wall

2.Pelvic floor

Pelvic diaphragm

Urogenital diaphragm
1.Lateral pevic wall

2.Pelvic floor

Pelvic diaphragm

Urogenital diaphragm
Lateral wall of pelvic muscle
1.Piriformis
Origion- ant. Aspect of s2-s4 and sacrotuberous ligament
Insertion- greater trochanter of femur
Action- lateral rotation, abduction of thigh, holds head of femur in accetabulum
Innervation- s1-s2 from muscular bed of sacral plexus

2. Obturator internus
Origin - medial wall of the pelvis (margin of Obturator foramen), runs through the lesser
sciatic foramen
Insertion - greater trochanter of the femur
Action - lateral rotation of thigh
Nerve supply- nerve to Obturator internus
3. Iliopsoas
Origin- lateral margin of lumbar vertebrae and illiac fossa
Insertion- lesser trochanter of femur
Action- flex thigh and vertebrae, stablize trunk with thigh
Levatorani
•Muscular floor of the pelvis and supports the viscera

The muscle can be divided into 3 parts:

puborectalis muscle
Pubococcygeus muscle
iliococcygeus muscle
Nerve supply
•nerve to levator ani (perineal branches of S3 & S4) and the inferior rectal nerve
•Action: raise pelvic floor
It forms a U-shaped muscular sling (puborectal sling) that passes posterior to the
anorectal junction.
This part plays a major role in maintaining fecal continence.(80, 130-140) angle
Injury to Pelvic Floor
During childbirth, the pelvic floor supports the fetal head.
The perineum, levator ani and pelvic fascia may be injured during childbirth.
It is the pubococcygeus, the main and most medial part of the levator ani, that is usually
torn.
because it encircles and supports the urethra, vagina, and anal canal.
Alter the position of the neck of the bladder and urethra.
It results urinary stress incontinence, characterized by dribbling of urine when intra-
abdominal pressure is raised during coughing
PELVIC VISCERA
The organization of pelvic viscera from anterior to posterior:
In the male: bladder, prostate, male genital organs and rectum

In the female: bladder, uterus and female genital organs and rectum
The pelvic viscera are partly covered by peritoneum in their upper aspects but are extra
peritoneal inferiorly.
•The peritoneum around and over the various pelvic structures in the pelvic cavity
produces several blind ended peritoneal pouch In male
–Rectovesical pouch: between the bladder and rectum In female
–Vesicouterine pouch: between bladder and uterus –Rectouterine pouch: between
rectum and uterus

Urinary bladder
•a smooth, collapsible, muscular sac that stores urine.
•Position
shape, size and position vary with amount of urine and age
In adults: empty bladder lies in pelvis minor posterior and slightly superior to pubic
bones.
When filled ascends to pelvic major and abdomen
In infants: found in abdomen
Enters pelvic major at about 6 years of age and pelvic minor at puberty
The bladder is very distensible and uniquely suited for its function of urine storage
Empty its walls are thick and thrown into folds (rugae)
As it expands it becomes pear shaped and rises in the abdominal cavity
The bladder can store more than 300 ml of urine without a significant increase in
internal pressure
A moderately full bladder holds approximately 500 ml and can about 1000 ml at
capacity
In males, the bladder lies immediately anterior to the rectum.
In females, the bladder is anterior to the vagina and uterus.

Arterial supply
Branches of internal iliac areteries
•Superior vesical artery: supply anterosuperior parts
•Inferior vesical artery and Vaginal artery: supply fundus in male and female,
respectively
Obturator and inferior gluteal arteries: small branches

Venous drainage
Correspond to arteries and drain into internal iliac vein

Innervation
Parasympathetic fibers from pelvic splanchnic nerves (S2,S3,S4)
Motor to muscle and inhibitory to internal sphincter
Sympathetic fibers from T11,T12,L1 & L2
Urethra
Tube extend from internal urethral orifice to exterior
passage way for discharging urine (and semen in male)
Male urethra
long, about 15-20cm
has 3 portions: prostatic, membranous and penile (spongy)
prostatic urethra
about 3cm long
passes through prostate
widest and most dilatable part
ejaculatory ducts open on each side of prostatic utricle

Blood supply
•Arterial supply
Prostatic urethra: prostatic branches of inferior vesical and middle rectal arteries
Membranous and spongy urethra: internal pudendal artery
•Venous drainage
veins accompany arteries and have similar names
•Inervation
Branches of pudendal nerve
Female urethra
•Exclusively a urinary organ and shorter (about 4cm) and simpler
•It opens 2 cm posterior to the clitoris in vestibule of vagina
•Its inferior end is surrounded by sphincter urethrae muscle
•Urethral glands are found in superior part called paraurethral glands

Blood supply: internal pudendal and vaginal vessels

Innervation: pudendal nerve and pelvic splanchnic nerves

Male internal genital organs

Ductus (vas) deferens
 Thick walled muscular tube, about 45cm long
• Continuation of ductus epididymis
• Blood supply: artery of ductus deferens and vein accompany artery
• Innervation: inferior Hypogastric plexus
Vasectomy: a method of sterilizing males in which part of ductus deferens is
ligated or excised
Seminal vesicles
• Thin-walled and pear-shaped
• About 5 cm long
• The seminal vesicles secrete a fluid which contributes to the semen.
– The secretion accounts for about 60% of the volume of the semen
– It is a yellowish, viscous, alkaline fluid (fructose, prostaglandins) for
sperm energy
• The ducts of the seminal vesicles join with the vas deferens to form the
ejaculatory ducts.
– Sperm cells and seminal fluid mix in the ejaculatory duct to enter the
prostatic urethra together during ejaculation.

• Blood supply: from inferior vesical and middle rectal arteries

• Veins accompany arteries
Innervation:
• sympathetic fibers from superior lumbar nerves
• Parasympathetic from pelvic splanchnic nerves
Ejaculatory ducts
• Formed by union of ducts of seminal vesicle and ductus(vas) deferens
• The ducts bilaterally converge to open on the seminal colliculus on either side of the
prostatic utricle
Prostate
• Enveloped in fibrous capsule and prostatic sheath
• Parts: base, apex, 4 surfaces (posterior, anterior and 2 inferolateral)
Base: related to neck of urinary bladder
Apex: related to fascia of urogenital diaphragm

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 Posterior surface: rest on rectum
Anterior surface: narrow and convex
Inferolateral surface: rests on levator ani fascia
 Secretes milky, slightly acidic prostate fluid
 About 25% of the volume of semen.

Medical application
• Benign prostatic hypertrophy (BPH)
– Present in 50% of men older than 50 years and in 95% of
men older than 70 years
– It generally occurs in the transition zone(middle lobe)
surrounding the urethra and can lead to compression of
the urethra
– Prostatic carcinoma occurs in ( peripheral zone)
Blood supply:
– arteries from inferior vesical and middle rectal arteries
– veins from plexus around sides and base which drain into
internal iliac vens
Innervation:
 parasympathetic-from pelvic splanchnic nerve
 sympathetic- from inferior hypogastric plexuses
• Disease of prostate may cause voiding problem because urethra
passes through it 60
Bulbo urethral gland (Cowper's )
• Lie posterolateral to membranous urethra, embedded in
sphincter urethrae muscle.
• Duct passes through perineal membrane and open in
proximal spongy urethra.
• Secrete alkaline mucus with lubrication.
• It accounts 15% of the semen
• It homologous with the Greater Vestibular Glands in
female
Female internal genital organs
Ovaries
 The female gonads
 primary reproductive organs
 Like the testes of the male, ovaries serve a dual purpose
 Produce gametes
 Produce female sex hormones (estrogen and
progesterone)
Ovaries
 The female gonads
 primary reproductive organs
 Like the testes of the male, ovaries serve a dual purpose
 Produce gametes
 Produce female sex hormones (estrogen and
progesterone)
Ligaments
• Each ovary is held in place within the peritoneal cavity by
several ligaments
 ovarian ligament
• anchors the ovary medially to the uterus
 Suspensory ligament
• anchors the ovaries laterally to the pelvic wall
 Mesovarium
• suspends the ovaries between the fallopian tubes
and the uterus
 • Both the suspensory ligament and the mesovarium are part
of the broad ligament
The ovaries and duct system, collectively known as the internal
genitalia are mostly located in the pelvic cavity.
 The female’s accessory ducts are the uterine tubes, uterus
and vagina
 The external sex organs of the females are referred to as the
external genitalia.